Physician Burnout in Canada: Challenges and Possible Future Interventions
DOI :
https://doi.org/10.15273/hpj.v1i2.10588Résumé
Background: Physicians are the backbone of the health-care industry, and the state of their well-being significantly influences the productivity, financial conditions and overall performance of the health care system. The objectives of this literature review are to highlight the challenges posed by physician burnout to the Canadian health care system and suggest possible recommendations to reduce this burnout. Methods: Database searches were conducted to study the effects of physician burnout on the health care system. Websites of organizations like the Canadian Medical Association, Canadian Medical Protective Association, Canadian Collaborative Centre for Physician Resources and Medical Council of Canada were searched. Research papers from Canada, the United States, Europe and Hong Kong were assessed to support the existence of burnout among physicians in Canada and globally. Results: Burnout affects the Canadian health care system in terms of estimated cost, patient safety, productivity, performance, COVID-19 pandemic response and future medical workforce supply. It was found that the level of physician burnout is increasing notably among the Canadian workforce, with the COVID-19 pandemic adding more stress to the situation. The costs of burnout rendered to the health care system are continually increasing each year in Canada. Many physicians across the world are considering retiring early, while others are considering quitting the profession altogether, adding to the pressure already imposed on the physicians remaining in the system. Recommendations to reduce burnout among physicians from the literature were studied as part of this review. Conclusion: Physician burnout has several negative impacts on the health care system. This literature review provides a concise overview of the major challenges posed by burnout among Canadian physicians. It will help contribute to plans and strategies to reduce physician burnout in the future.
Références
Boyle, T. (2018, October 10). Canadian doctors are suffering from burnout at an ‘alarming‘ rate, survey finds. The Star. https://www.thestar.com/news/gta/2018/10/10/md-burnout-an-alarming-problem-cma-president-says.html
Canadian Collaborative Centre for Physician Resources. (2013). Canadian physician resources – 2013 basic facts.
Canadian Institute for Health Information. (2014). National health expenditure trends, 1975 to 2014. https://publications.gc.ca/collections/collection_2015/icis-cihi/H118-2-2014-eng.pdf
Canadian Medical Association. (2013). Physicians per 100,000 population by province/territory, Canada, 1986-2015. https://www.cma.ca/sites/default/files/pdf/Physician%20Data/12-Phys_per_pop.pdf
Canadian Medical Association. (2017). Average hours worked per week by physicians, 1997–2017. https://www.cma.ca/sites/default/files/pdf/Physician%20Data/34-TrendData-e.pdf
Canadian Medical Association. (2018). CMA National Physician Health Survey: A national snapshot. https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf
Chan, B. T. B. (2002, June). From perceived surplus to perceived shortage: What happened to Canada‘s physician workforce in the 1990s? Canadian Institute for Health Information. https://secure.cihi.ca/free_products/chanjun02.pdf
Chochinov, A., & Lim, R. (2020). On the brink of burnout: COVID-19 and the ER. Canadian Association of Emergency Physicians. https://caep.ca/wp-content/uploads/2020/03/CAEP-Wellness-OpEd_Final_Clean.pdf
De Simone, S., Vargas, M., & Servillo, G. (2019). Organizational strategies to reduce physician burnout: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 33(4), 883–894. https://doi.org/10.1007/s40520-019-01368-3
Dewa, C. S., Jacobs, P., Thanh, N. X., & Loong, D. (2014). An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. BMC Health Services Research, 14, Article 254. https://doi.org/10.1186/1472-6963-14-254
Dewa, C. S., Loong, D., Bonato, S., Thanh, N. X., & Jacobs, P. (2014). How does burnout affect physician productivity? A systematic literature review. BMC Health Services Research, 14, Article 325. https://doi.org/10.1186/1472-6963-14-325
Dobbins, M. (2017, July 12). Rapid review guidebook: Steps for conducting a rapid review. National Collaborating Centre for Methods and Tools. https://www.nccmt.ca/uploads/media/media/0001/01/a816af720e4d587e13da6bb307df8c907a5dff9a.pdf
Drummond, D. (2015). Physician burnout: Its origin, symptoms, and five main causes. Family Practice Management, 22(5), 42–47. https://www.aafp.org/fpm/2015/0900/p42.html
Dyrbye, L. N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A.,
Harper, W., Durning, S., Moutier, C., Szydlo, D. W., Novotny, P. J., Sloan, J. A., & Shanafelt, T. D. (2008). Burnout and suicidal ideation among U.S. medical students. Annals of Internal Medicine, 149(5), 334–341. https://doi.org/10.7326/0003-4819-149-5-200809020-00008
Garland, A., Roberts, D., & Graff, L. (2012). Twenty-four-hour intensivist presence: A pilot study of effects on intensive care unit patients, families, doctors, and nurses. American Journal of Respiratory and Critical Care Medicine, 185(7), 738–743. https://doi.org/10.1164/rccm.201109-1734OC
Gulati, G., & Kelly, B. D. (2020). Physician suicide and the COVID-19 pandemic. Occupational Medicine, 70(7), 514. https://doi.org/10.1093/occmed/kqaa104
Ireland, S. (2021, April 27). Revealed: Countries with the best health care systems, 2021. CEOWORLD Magazine. https://ceoworld.biz/2021/04/27/revealed-countries-with-the-best-health-care-systems-2021/
Ivan, I. (n.d.). Post graduation pathways in the UK for IMGs. Road to UK. https://www.roadtouk.com/postgraduation/postgraduation-pathways/
Kuhn, C.M., & Flanagan, E.M. (2017). Self-care as a professional imperative: Physician burnout, depression, and suicide. Canadian
Journal of Anesthesia, 64, 158–168. https://doi.org/10.1007/s12630-016-0781-0
Linzer, M., Poplau, S., Grossman, E., Varkey, A., Yale, S., Williams, E., Hicks, L., Brown, R. L., Wallock, J., Kohnhorst, D., & Barbouche, M. (2015). A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: Results from the Healthy Workplace (HWP) Study. Journal of General Internal Medicine, 30(8), 1105–1111. https://doi.org/10.1007/s11606-015-3235-4
Malko, A. V., & Huckfeldt, V. (2017). Physician shortage in Canada: A review of contributing factors. Global Journal of Health Science, 9(9), 68–80. https://doi.org/10.5539/gjhs.v9n9p68
Martin, S. (2002). More hours, more tired, more to do: Results from the CMA‘s 2002 Physician Resource Questionnaire. CMAJ : Canadian Medical Association Journal, 167(5), 521–522. https://www.cmaj.ca/content/167/5/521.1
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. https://doi.org/10.1002/job.4030020205
Medical Council of Canada. (n.d.). Medical Council of Canada Qualifying Examination Part I. https://mcc.ca/examinations/mccqe-part-i/
Olson, K. D. (2017). Physician burnout—A leading indicator of health system performance? Mayo Clinic Proceedings, 92(11), 1608–1611. https://doi.org/10.1016/j.mayocp.2017.09.008
Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., Dawson, S., van Marwijk, H., Geraghty, K., & Esmail, A. (2017). Controlled interventions to reduce burnout in physicians: A systemic review and meta-analysis. JAMA Internal Medicine, 177(2), 195–205. https://doi.org/10.1001/jamainternmed.2016.7674
Parker, J., & Mirzaali, M. (2020, March 16). The moral cost of coronavirus. Journal of Medical Ethics Blog. https://blogs.bmj.com/medical-ethics/2020/03/16/the-moral-cost-of-coronavirus/
Ruitenburg, M. M., Frings-Dresen, M. H. W. & Sluiter, J. K. (2012). The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: A cross-sectional study. BMC Health Services Research, 12, Article 292. https://doi.org/10.1186/1472-6963-12-292
Salyers, M. P., Bonfils, K. A., Luther, L., Firmin, R. L., White, D. A., Adams, E. L., & Rollins, A. L. (2017). The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. Journal of General Internal Medicine 32(4), 475–482. https://doi.org/10.1007/s11606-016-3886-9
Shanafelt, T. D., Lightner, D. J., Conley, C. R., Petrou, S. P., Richardson, J. W., Schroeder, P. J., Brown, W. A. (2017). An organizational model to assist individual physicians, scientists, and senior health care administrators with personal and professional needs. Mayo Clinic Proceedings, 92(11), 1688–1696. https://doi.org/10.1016/j.mayocp.2017.08.020
Shea, J. A., Bellini, L. M., Dinges, D. F., Curtis, M. L., Tao, Y., Zhu, J., Small, D. S., Basner, M., Norton, L., Novak, C., Dine, J., Rosen, I. M., & Volpp, K. G. (2014). Impact of protected sleep period for internal medicine interns on overnight call on depression, burnout, and empathy. Journal of Graduate Medical Education, 6(2), 256–263. https://doi.org/10.4300/JGME-D-13-00241.1
Sinsky, C. A., Dyrbye, L. N., West, C. P., Satele, D., Tutty, M., & Shanafelt, T. D. (2017). Professional satisfaction and the career plans of US physicians. Mayo Clinic Proceedings, 92(11), 1625–1635. https://doi.org/10.1016/j.mayocp.2017.08.017
Siu, C. F. Y., Yuen, S. K., & Cheung, A. (2012). Burnout among public doctors in Hong Kong: Cross-sectional survey. Hong Kong Medical Journal, 18(3), 186–192. https://www.hkmj.org/abstracts/v18n3/186.htm
Slade, S. (2014). IMGs in Canada: Data and the changing gestalt [PowerPoint slides]. Royal College of Physicians and Surgeons of Canada. https://www.royalcollege.ca/rcsite/documents/health-policy/imgs-in-canada-feb-2014-steve-slade.pdf
Soler, J. K., Yaman, H., Esteva, M., Dobbs, F., Asenova, R. S., Katic, M., Ozvacic, Z., Desgranges, J. P., Moreau, A., Lionis, C., Kotanyi, P., Carelli, F., Nowak, P. R., de Aguiar Sa Azeredo, Z., Marklund, E., Churchill, D., Ungan, M., & European General Practice Research Network Burnout Study Group. (2008). Burnout in European family doctors: The EGPRN study. Family Practice, 25(4), 245–265. https://doi.org/10.1093/fampra/cmn038
The Canadian Medical Protective Association. (2018a). Healthier physicians: An investment in safe medical care. https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-meeting/18_healthier_physicians_backgrounder-e.pdf
The Canadian Medical Protective Association. (2018b, August 22). Canadian Medical Protective Association calls for system-wide change to improve physician wellness [Press release]. https://www.cmpa-acpm.ca/en/connect/media-room/2018/canadian-medical-protective-association-calls-for-system-wide-change-to-improve-physician-wellness
Vo, E. (2019, August 30). Why do you discount cash flows? The Hartford. https://sba.thehartford.com/finance/cash-flow/discounting-cash-flows/
World Health Organization. (2010). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. https://www.who.int/workforcealliance/knowledge/toolkit/26/en/
